Escard E, Barret L
Médecin légiste, assistant des hôpitaux, département d'anthropologie, Université Laval, Québec.
Paediatr Child Health. 2003 Mar;8(3):151-4. doi: 10.1093/pch/8.3.151.
Congenital insensitivity to pain is a rare illness that can cause accidental external and internal injuries in children. When child abuse is suspected, the awareness of this illness can complicate any medicolegal interpretation of findings.Several components are needed to diagnose congenital insensitivity to pain: lack of sensitivity to pain since birth; involvement of the whole body; integrity of osteotendinous reflexes; and other sensitivity processes and negative paraclinical, including histological, examinations.This article describes the case of two siblings examined during an emergency legal procedure at the forensic medicine unit of the Grenobles University Hospital Centre in France. The medico-legal interpretation of facts and examinations must be conservative in case of legal complications and must follow an analysis of the child's and family's medicosocial problems since the child's birth. The family's socioeducational support and the communication of information on this illness should be a priority to avoid any misunderstanding and overrun in the child's management and monitoring.
先天性无痛觉是一种罕见疾病,可导致儿童意外的外部和内部损伤。当怀疑存在虐待儿童情况时,对这种疾病的认知会使对检查结果的任何法医学解释变得复杂。诊断先天性无痛觉需要几个要素:自出生起就对疼痛缺乏敏感性;累及全身;骨腱反射完整;以及其他感觉过程和包括组织学检查在内的辅助检查呈阴性。本文描述了在法国格勒诺布尔大学医院中心法医学科的一次紧急法律程序中对两名兄弟姐妹进行检查的案例。在出现法律纠纷的情况下,对事实和检查结果的法医学解释必须保守,并且必须对自孩子出生以来其家庭的社会医疗问题进行分析。家庭的社会教育支持以及关于这种疾病的信息交流应成为优先事项,以避免在儿童管理和监测方面出现任何误解和失误。